Serious inaccuracies in the draft Medicare & You Handbook for 2019

One issue called out in the letter:

Even more problematic is the treatment of prior authorization requirements in Medicare Advantage. On both page 6 and page 62, the Handbook attempts to paint this restriction on access to services as a benefit, rather than as what it is, a mandatory hurdle for Medicare Advantage members that is not required for individuals in Original Medicare. On page 62, the Handbook goes so far as to describe prior authorization as a “right” that people in Original Medicare “can’t get.” Describing a restriction as a “right” and then saying that people who are not subject to this restriction are disadvantaged twists the
facts beyond recognition.

Further, people in Original Medicare actually do have a right to receive a written notice prior to receiving care if the provider thinks the care will not be covered by Medicare (the Advanced Beneficiary Notice, or ABN). In our experience, beneficiaries find prior authorization to be an obstacle to accessing care. We doubt even the most aggressive plan agent or broker would try to convince a beneficiary that having to get a prior authorization is one of the benefits of joining a Medicare Advantage plan.